Volume Overload LVH

Report:

Sinus rhythm 75/min

Left atrial abnormality

Left ventricular hypertrophy voltage

Prominent T waves c/w volume overload

Comment:

In the diastolic overload of chronic aortic or mitral incompetence T waves may not only remain upright with LVH, but grow to some prominence, as in this case. Eventually this evolves into LVH with ST/T changes indistinguishable from the pressure (systolic) overload one.

Interestingly, the voltages were smaller and the LAA more prominent day before (below, Fig 2a), when the patient admitted in pulmonary (and some peripheral) œdema. Fluid retention appears to diminish QRS voltage in a variety of clinical settings3. As to the LAA, the PTF has long been known to change with left atrial pressures4.

In general, voltage variability observed in clinical practice, however marked, rarely abolishes the ECG diagnosis of LVH.

2a. Smaller voltages and more prominent LAA with pulmonary œdema in Casualty. 3. 72 year old lady in shock following a car crash

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